Preterm Birth Rates and TwinsThread
May 08, 2010 12:54 PM
Thank you for taking the time to consider my question.
I've been looking into the rise in preterm birth rates among twin pregnancies, and I keep finding the explanation for the rise in preterm birth rates in twins as being accounted for largely by the decline in stillbirth rates. It appears to me, however, that the decline in stillbirths is much smaller than the rise in preterm births. I strongly suspect that the sort of prenatal care given to twin mothers is largely responsible for the rise in preterm births.
This impression has formed in part from my own experience as a mother of twins. When I could not find a midwife who would be willing to take me on as a patient, due to the prohibitive nature of their malpractice insurance, I tried very hard to reconcile myself with having to go to the hospital for my prenatal care and delivery. The prospect filled me with despair - I often cried bitterly. I researched what it is I would have to contend with, and became more and more convinced that my desire for homebirth attended by midwives was not just a matter of personal preference but truly the safer thing for me and for my babies.
I persisted in my search for a midwife or three and finally did find some very competant and certified midwives who deliberately did not carry malpractice insurance for the sake of giving people like me the choice to birth in the way I believe best. Although it remains the case that twin mamas cannot by law give birth in a birth center. I recieved excellent and supportive prenatal care that did not serve to stress me out with worry and constant surveillence of my womb, babies, and cervix. I ate well, rested as needed, and carried my twins to 39 weeks before having a wonderful and succesful homebirth. It turns out I had one red baby, one white. That is to say, my monochorionic twins had in fact developed TTTS. They were of similar size and health, however, and I think that following Elizabeth Noble's advice on eating a great deal of protein did a great deal of good in this case. I think that if this had been discovered during the constant scanning I would have received under the care of an OB, the knowledge of it would have scared me greatly, and I probably would have consented, within that state of fear, to any and all interventions - including induction or a preterm, scheduled cesarian section surgury. The story could have ended much, much worse than it did.
I am eternally grateful to my midwives for allowing me, despite personal risk, to have my own way. I do believe through use of reason that I chose the best possible path for my pregnancy and my babies' arrival.
I hope you don't mind my giving my personal background to my question. I really would appreciate some help in understanding the medical research data. It just does not seem possible that the rise in preterm birth rates for twins is due merely to our being better able to prevent babies from dying in the womb by extracting them and using our excellent NICUs.
Thank you for all of your excellent work.
May 10, 2010 02:03 AM
I'm glad all worked out well for you, but it makes me sad and angry that you should have been forced into the dilemma of having to choose the least worst option. Women with higher risk potential such as yourself should be able to obtain care that promotes healthy pregnancy and natural birth in an environment equipped to deal with complications should they occur. Women should also have access to complete, objective information about the pros and cons of their options and the ultimate say in what decisions are made about their care. That just isn't happening with typical medical management.
As for the research, I haven't looked at twins, but I recommend Elizabeth Noble's book Having Twins and More. She noted that that the preterm birth rate for twins was much higher than when she had written the first edition of the book although back then, before everyone had an early ultrasound scan, twins were often not diagnosed until the third trimester and therefore did not have high-risk management practically from day 1. She thinks that high-risk management may actually be the culprit. Preterm birth is strongly associated with chronically high stress levels and medical management of twin pregnancy is nothing if not highly stressful.
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